Efficacy and moderators of short-term psychodynamic psychotherapy for depression: A systematic review and meta-analysis of individual participant data,Clinical Psychology Review

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Efficacy and moderators of short-term psychodynamic psychotherapy for depression: A systematic review and meta-analysis of individual participant data
Clinical Psychology Review ( IF 12.8 ) Pub Date : 2023-03-16 , DOI: 10.1016/j.cpr.2023.102269
Frederik J Wienicke ₁ , Manfred E Beutel ₂ , Rüdiger Zwerenz ₂ , Elmar Brähler ₃ , Peter Fonagy ₄ , Patrick Luyten ₅ , Matthew Constantinou ₄ , Jacques P Barber ₆ , Kevin S McCarthy ₇ , Nili Solomonov ₈ , Peter J Cooper ₉ , Leonardo De Pascalis ₁₀ , Robert Johansson ₁₁ , Gerhard Andersson ₁₂ , Alessandra Lemma ₁₃ , Joel M Town ₁₄ , Allan A Abbass ₁₄ , Bita Ajilchi ₁₅ , Mary Beth Connolly Gibbons ₁₆ , Jaime López-Rodríguez ₁₇ , Valerio Villamil-Salcedo ₁₇ , Giuseppe Maina ₁₈ , Gianluca Rosso ₁₈ , Jos W R Twisk ₁₉ , William J Burk ₂₀ , Jan Spijker ₂₁ , Pim Cuijpers ₂₂ , Ellen Driessen ₂₁

Affiliation

Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany; Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.
Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Department of Clinical, Educational and Health Psychology, University College London, London, UK; Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.
Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, USA.
Department of Psychology, Chestnut Hill College, Philadelphia, PA, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, USA.
School of Psychology and Clinical Language Science, University of Reading, Reading, UK.
Department of Psychological Science, University of Liverpool, Liverpool, UK; Department of Psychology, University of Bologna, Bologna, Italy.
Department of Psychology, Stockholm University, Stockholm, Sweden.
Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Anna Freud National Center for Children and Families, London, UK.
Center for Emotions & Health, Dalhousie University, Halifax, Nova Scotia, Canada.
Department of Psychology, Faculty of Human Science, Science and Research Branch, Islamic Azad University, Tehran, Iran.
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
National Institute of Psychiatry, Mexico City, Mexico.
Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, the Netherlands.
Department of Developmental Psychology, Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.
Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands; Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, the Netherlands.
Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.

Background

Short-term psychodynamic psychotherapy (STPP) is frequently used to treat depression, but it is unclear which patients might benefit specifically. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses and identify patient-level moderators. This IPD meta-analysis examined the efficacy and moderators of STPP for depression compared to control conditions.

Methods

PubMed, PsycInfo, Embase, and Cochrane Library were searched September 1st, 2022, to identify randomized trials comparing STPP to control conditions for adults with depression. IPD were requested and analyzed using mixed-effects models.

Results

IPD were obtained from 11 of the 13 (84.6%) studies identified (n = 771/837, 92.1%; mean age = 40.8, SD = 13.3; 79.3% female). STPP resulted in significantly lower depressive symptom levels than control conditions at post-treatment (d = −0.62, 95%CI [−0.76, −0.47], p < .001). At post-treatment, STPP was more efficacious for participants with longer rather than shorter current depressive episode durations.

Conclusions

These results support the evidence base of STPP for depression and indicate episode duration as an effect modifier. This moderator finding, however, is observational and requires prospective validation in future large-scale trials.

中文翻译：

抑郁症短期心理动力学心理治疗的疗效和调节因素：个体参与者数据的系统回顾和荟萃分析

背景

短期心理动力学心理治疗 (STPP) 常用于治疗抑郁症，但尚不清楚哪些患者可能特别受益。个体参与者数据 (IPD) 荟萃分析可以提供比传统荟萃分析更精确的效果估计，并确定患者水平的调节因素。与对照条件相比，该 IPD 荟萃分析检查了 STPP 对抑郁症的疗效和调节剂。

方法

2022 年 9 月 1 日检索了 PubMed、PsycInfo、Embase 和 Cochrane 图书馆，以确定将 STPP 与成人抑郁症对照条件进行比较的随机试验。使用混合效应模型请求和分析 IPD。

结果

IPD 从确定的 13 项研究中的 11 项 (84.6%) 获得（n = 771/837，92.1%；平均年龄 = 40.8，SD = 13.3；79.3% 为女性）。在治疗后，STPP 导致抑郁症状水平显着低于对照条件（d = −0.62, 95%CI [−0.76, −0.47], p < .001）。在治疗后，STPP 对于当前抑郁发作持续时间较长而不是较短的参与者更有效。